The Effects of Neuromodulation on Phonatory Function in Laryngeal Dystonia

Status: Recruiting
Location: See location...
Intervention Type: Device
Study Type: Interventional
Study Phase: Not Applicable
SUMMARY

Laryngeal dystonia (LD) causes excessive vocal fold abduction (opening) or adduction (closing) leading to decreased voice quality, job prospects, self-worth and quality of life. Individuals with LD often experience episodic breathy voice, decreased ability to sustain vocal fold vibration, frequent pitch breaks and in some cases, vocal tremor. While neuroimaging investigations have uncovered both cortical organization and regional connectivity differences in structures in parietal, primary somatosensory and premotor cortices of those with LD, there remains a lack of understanding regarding how the brains of those with LD function to produce phonation and how these might differ from those without LD. Intervention options for people with LD are limited to general voice therapy techniques and Botulinum Toxin (Botox) injections to the posterior cricoarytenoid (PCA) and/or TA (thyroarytenoid) often bilaterally, to alleviate muscle spasms in the vocal folds. However, the effects of injections are short-lived, uncomfortable, and variable. To address this gap, the aim of this study is to investigate the effectiveness of repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulation technique, in assessing cortical excitability and inhibition of laryngeal musculature. Previous work conducted by the investigator has demonstrated decreased intracortical inhibition in those with adductor laryngeal dystonia (AdLD) compared to healthy controls. The investigators anticipate similar findings in individuals with with other forms of LD, where decreased cortical inhibition will likely be noted in the laryngeal motor cortex. Further, following low frequency (inhibitory) rTMS to the laryngeal motor brain area, it is anticipated that there will be a decrease in overactivation of the TA muscle. To test this hypothesis, a proof-of-concept, randomized study to down-regulate cortical motor signal to laryngeal muscles will be compared to those receiving an equal dose of sham rTMS. Previous research conducted by the investigator found that a single session of the proposed therapy produced positive phonatory changes in individuals with AdLD and justifies exploration in LD.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 21
Maximum Age: 85
Healthy Volunteers: t
View:

• Age range is 21-85 years

• Diagnosis of Laryngeal Dystonia (LD)

• Subject is able to give informed consent

• Symptoms at worst severity if receiving botulinum toxin injections

• Subject has signed the consent form

Locations
United States
Massachusetts
Teresa J Kimberley
RECRUITING
Boston
Contact Information
Primary
Caitlin Koehler, Lab Manager
brainrecoverylab@mghihp.edu
617-643-6564
Backup
Teresa J Kimberley, PhD, PT
tkimberley@mgh.harvard.edu
617-643-9237
Time Frame
Start Date: 2021-06-10
Estimated Completion Date: 2025-12-31
Participants
Target number of participants: 25
Treatments
Active_comparator: repetitive transcranial magnetic stimulation (rTMS)
5 consecutive days of rTMS to the individualized, targeted, left laryngeal motor cortex associated with laryngeal function to down-regulate cortical motor signal to intrinsic laryngeal muscles and improve vocal function of individuals with LD.
Sham_comparator: Sham rTMS
5 consecutive days of sham rTMS to the individualized, targeted, left laryngeal motor cortex associated with laryngeal function to down-regulate cortical motor signal to intrinsic laryngeal muscles and improve vocal function of individuals with LD.
Sponsors
Collaborators: National Institute on Deafness and Other Communication Disorders (NIDCD)
Leads: MGH Institute of Health Professions

This content was sourced from clinicaltrials.gov